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HIV status no longer barrier to pregnancy

Danielle Layman-Pleet didn't get very far the first few times she asked doctors about getting pregnant. &#34;I was told they wouldn't be able to work with me because of my HIV status,&#34; says Layman-Pleet, who was diagnosed with HIV in 2001. &#34;It was difficult and frustrating because I was told I didn't have any options.&#34;

Danielle Layman-Pleet didn't get very far the first few times she asked doctors about getting pregnant. "I was told they wouldn't be able to work with me because of my HIV status," says Layman-Pleet, who was diagnosed with HIV in 2001. "It was difficult and frustrating because I was told I didn't have any options."

``No" is often the first thing HIV-positive women hear when they say they want to have a baby. But infectious disease specialists say advances in medical and pregnancy care mean people with HIV should have the chance to have a family just like anyone else.

"There is still a lot of discrimination and stigma that surround HIV," says Dr. Mona Loutfy, an infectious disease specialist and scientist at the Women's College Research Institute. It's an outdated mindset that she and her team are working to change.

Loutfy says a combination of factors have made it possible for HIV-positive individuals to have children. HIV is largely considered a chronic disease that can be managed with medication, she says. New statistics out this year show life expectancy for people with HIV is the same as for the general population. And, she adds, advances in pregnancy care – HIV-positive women take a special drug combination to suppress the virus, Caesarean-section deliveries when necessary – mean there is less than a 1 per cent chance of women passing the infection to their children.

"Now, it's no different than someone with diabetes having a child," Loutfy says.

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Research by Loutfy and her team show 69 per cent of HIV-positive women in Ontario who are in their reproductive years want to get pregnant, while 57 per cent intend to have a baby. There are close to 4,000 HIV-positive women of reproductive age in Ontario.

Loutfy says the study, to be published Monday in the journal PloS (Public Library of Science) ONE, is the first accurate measure of the need to help HIV-positive women in Ontario have a family. The results, which are higher than previous North American studies, are similar to the proportion of HIV-positive women in Africa who report wanting a family. According to Loutfy, this makes sense because new immigrants make up a large proportion of HIV cases in Ontario.

Loutfy and her team are drawing up provincial and national pregnancy clinical planning guidelines for people with HIV. To be released early in 2010, they will educate health professionals about how HIV-positive people can plan for a safe pregnancy and a healthy baby.

A couple that includes an HIV-positive man, for example, will need the help of a fertility clinic. A technique called sperm washing can separate healthy sperm from infected sperm.

Only five fertility clinics in Ontario treat this population. This summer, Mount Sinai Hospital's Centre for Fertility and Reproductive Health opened a new quarantined laboratory to give patients with different viruses, including Hepatitis B, Hepatitis C and HIV, year-round access to fertility treatments.

"We felt it was the right thing to do," says Dr. Ellen Greenblatt, the fertility centre's medical director. "We now have to think beyond a cure to quality of life."

Layman-Pleet is now seven months pregnant. The 32-year-old health policy adviser, who lives in Toronto with her partner, was able – with guidance from Loutfy – to find a fertility clinic to help her get pregnant with donor sperm.

She is healthy, excited and loves to track the movements of the baby. All of this is so much more than she expected after hearing her HIV diagnosis eight years ago.

"At first, one of your initial thoughts is you are going to die," she says. "But now, I'm thinking about what I want to create in my life, and that includes having kids."

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